背景：儘管開胸手術後止痛技術的進步緩解了病患在手術時產生的急性疼痛，有助減少病人住院的時間，但慢性開胸手術術後疼痛（CPTP）仍然困擾著患者。CPTP可能來自肋間神經的受損而導致病患有顯著的神經性症狀，如痛覺過敏和感覺異常。患有異常感覺的患者估計持續數月甚至數年，流行病學上發病率高達40％。 這類疼痛感將影響功能性的活動以及生活品質，雖然已有提出藥物可以減少傷口的疼痛感，但我們想要探討一個非藥物的有效介入，因此本研究將在實驗用大鼠上進行開胸手術，探討是否能藉由跑步機運動改善開胸手術慢性疼痛的症狀。
方法：雄性實驗用大鼠(SD rats)隨機分為5組：開胸手術組(TTR)，開胸手術加上運動組（TRR-E），假手術組(Sham)，假手術加上運動組以及控制組。手術後第10天進行為期6周的跑步機訓練，研究者會藉由Von-Frey以及丙酮測試量化疼痛相關的行為並做紀錄。
結果：開胸手術後第10天，大鼠表現出明顯對輕觸覺刺激及冷刺激的過度敏感。TRR組和TRR-E組的閾值相對於控制組有明顯的減少。在跑步機介入後第28天TRR-E組的機械性退縮閾值相較於TRR組有明顯的上升，但仍然低於控制組的; 對於冷的感覺異常在第28天後也有逆轉的現象，而另外三組的閾值在實驗中是相似的，沒有達到顯著差異。 在介白素-1beta (IL-1β)與腫瘤壞死因子-α(TNF-α)的表現上，開胸手術過後的老鼠相較於控制組老鼠有顯著的增加，跑步機介入後，雖然與手術組沒有達顯著差異，但表現水平有減少的趨勢。
結論: 我們結論出跑步機的介入減緩了慢性胸廓切開術後的疼痛。 這似乎為臨床患者提供了有效的方法，有助於他們疼痛管理以及生活質量的提升。
Background: Although advances in analgesia techniques have alleviated the acute pain that occurs after thoracotomy, which reduces the length of hospital stay, but chronic pain after thoracotomy (CPTP) still bother patients. CPTP may be caused by damage to the intercostal nerves result in significant neurological symptoms such as hyperalgesia and allodynia. Patients with abnormal sensations are estimated to last for months or even years, with an epidemiological incidence of up to 40%. This pain will affects functional activity and quality of life. Despite drug can partially suppress pain around surgical wound, but we want to explore a non-pharmaceutical intervention. In this study, we will evaluate whether treadmill exercise training reduces chronic post-thoracotomy pain in a rat model after thoracotomy.
Methods: Male SD rats were distributed randomly into 5 groups: thoracotomy with rib retraction group (TRR) and TRR with treadmill exercise group (TRR-E), thoracotomy without rib retraction group (Sham), thoracotomy without rib retraction with exercise group (Sham-E), and control group. After thoracotomy procedure, the rats were trained to run for 6 weeks. Pain-related behavioural test was measured and the threshold was being record by Von-Frey filaments or acetone.
Result: On day 10 after thoracotomy, rats exhibited a marked and continued hypersensitivity to von Frey tactile and cold stimuli. The threshold of TRR and TRR-E group were significant decrease compared with control group (P < 0.05), but there are similar within Sham and sham-E group. Mechanical withdrawal thresholds were increased compared with TRR (P < 0.05) following 35 days of treadmill intervention, but thresholds remained lower than control rats; moreover, cold allodynia was also reversed on 35 days in TRR-E group (P < 0.05). The threshold was not obvious different within other 3 groups in the experiment. After thoracotomy, rats demonstrated higher IL-1βand TNF-αexpression than control group, and showed decrease trend after 6 weeks treadmill intervention.
Conclusion: We concluded that forced treadmill running alleviated chronic post-thoracotomy pain. This appear provide an effective way for patients in clinical, it's helpful about their pain management and life quality.
